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Opportunistic Infections & Other Complications: Candida




 

Seattle Treatment Education Project (STEP) Perspective, Vol. 5, No. 2 -

There were numerous reports of fluconazole resistant candida albicans presented. The mechanism for this resistance is not totally understood. Some reports suggest that most resistant strains were newly acquired isolates, while other reports have shown that the same strain persists and develops increased fluconazole MIC (minimun inhibitory concentration) over time. Clinical failure seems to be associated with an MIC greater than 12.5 mcg/ml (WS-B12-1). Many isolates have an MIC of greater than 80 mcg/ml (PO-Bb09-1358, PO-B09-1372). Many of the strains which are resistant to fluconazole are sensitive to itraconazole. However, problems with poor bioavailablity of the itraconazole capsules often leads to treatment failure. The use of cyclodextrin solution formulation of itraconazole provided for more consistant absorption of the drug, leading to a response in more than 50% of the individuals who had failed using itraconazole capsules (WS-B12-2). Amphotericin B, liposomal amphotericin B, or alternating amphotericin B and itraconazole are also effective in fluconazole resistant candida (PO-B09-1362, PO-B09-1358).

Numerous studies showed fluconazole to be an effective prophylaxis against recurrent candida. One study showed that 50 mg of fluconazole three times per week was effective in preventing new instances of mucosal candidal infections in women. Nine of 17 women being intensly monitored but receiving no prophylaxis developed mucosal candida, whereas only three of 17 women receiving the fluconazole did, and two of these incidents were due to non-compliance (PO-B09-1369). Another study followed 99 individuals with esophageal candidiasis who received 100 mg of fluconazole a day to prevent relapse. All individuals had CD4 counts less than 100. Only seven individuals relapsed and mild side effects were reported in only eight individuals (PO-B09-1378). However, there are differing opinions as to whether or not fluconazole prophylaxis increases the occurrence of resistance.



 


Copyright © 1993 -STEP, Publisher. All rights reserved to Seattle Treatment Education Project, 1123 East John Street, Seattle, WA 98102. (206) 329-4857 or (877) 597-STEP [7837] (toll-free, valid only in the Pacific Northwest: Washington, Oregon, Idaho, Alaska, and Montana) e-mail Seattle Treatment Education Project

Information in this article was accurate in March 10, 1993. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.